Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Morin C[original query] |
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Prescription medication use among Canadian children and youth, 2012 to 2017
Servais J , Ramage-Morin PL , Gal J , Hales CM . Health Rep 2021 32 (3) 3-16 BACKGROUND: Prescription medications are used throughout the life course, including among children and youth. Prescribing practices may be influenced by emerging medical conditions, the availability of new medications, changing clinical practices, and evolving knowledge of the safety and effectiveness of medications. The Canadian Health Measures Survey (CHMS) provides national-level information to help monitor the use of prescribed medications in the population. DATA AND METHODS: Based on data from the CHMS (2012 to 2017), this article describes prescription medication use in the past month among those aged 3 to 19 years. Information on up to 45 prescription medications was recorded and classified according to Health Canada's Anatomical Therapeutic Chemical classification. Frequencies and bivariate analyses examined medication use by sociodemographic and health-related factors. The most common medication classes were identified for each age group. RESULTS: An estimated 23% of Canadian children and youth (1.5 million) had used at least one prescription medication in the past month and 9% had used two or more prescription medications.Prescription medication use was more common among those who reported lower levels of general and mental health, as well as among those with asthma (51%), a mood disorder (71%), attention deficit disorder (60%) or a learning disability (43%). Medications for the respiratory and nervous systems were among those most commonly prescribed. Of youth aged 14 years or older, 4% had misused prescription medications for non-medicinal purposes, for the experience, for the feeling they cause or to get high. DISCUSSION: Prescription medication use among children and youth is common in Canada. It is associated with lower levels of self-reported health and the presence of chronic conditions. The estimates provide a benchmark to help monitor prescription drug use in Canada. |
Case-control study of vaccine effectiveness in preventing laboratory-confirmed influenza hospitalizations in older adults, United States, 2010-11
Havers FP , Sokolow L , Shay DK , Farley MM , Monroe M , Meek J , Kirley PD , Bennett NM , Morin C , Aragon D , Thomas A , Schaffner W , Zansky SM , Baumbach J , Ferdinands J , Fry AM . Clin Infect Dis 2016 63 (10) 1304-1311 BACKGROUND: Older adults are at increased risk of influenza-associated complications, including hospitalization, but influenza vaccine effectiveness (VE) data are limited for this population. We conducted a case-control study to estimate VE to prevent laboratory-confirmed influenza hospitalizations among adults aged ≥50 years in eleven U.S. Emerging Infections Program (EIP) hospitalization surveillance sites. METHODS: Cases were RT-PCR-confirmed influenza infections in adults ≥50 years old hospitalized during the 2010-11 influenza season identified through EIP surveillance. Community controls, identified through home telephone lists, were matched by age group (+/- 5 years), county, and month of case hospitalization. Vaccination status was determined by self-report (with location and date) or medical records. Conditional logistic regression models were used to calculate adjusted VE (aVE) estimates [100 x (1 - adjusted odds ratio)] adjusting for sex, race, socioeconomic factors, smoking, chronic medical conditions, recent respiratory hospitalizations, and functional status. RESULTS: Among case-patients, 205/368 (55%) were vaccinated; 489/773 (63%) of controls were vaccinated. Case-patients were more likely to be persons of non-white race, with ≥2 chronic health conditions, with a recent hospitalization for a respiratory condition, with an income <$35,000, and report a lower functional status score (P-values <0.01 for all). Adjusted VE was 56.8% (95% confidence interval (CI): 34.1%-71.7%) and was similar by age, including adults ≥75 years [aVE 57.3% (95% CI 15.9%-78.4%)]. CONCLUSION: During 2010-11, influenza vaccination was associated with a significant reduction of the risk of laboratory-confirmed influenza hospitalization among adults aged ≥50 years regardless of age group. |
Benefit of Early Initiation of Influenza Antiviral Treatment to Pregnant Women Hospitalized With Laboratory-Confirmed Influenza
Oboho I , Reed C , Gargiullo P , Leon M , Aragon D , Meek J , Anderson EJ , Ryan P , Lynfield R , Morin C , Bargsten M , Zansky S , Fowler B , Thomas A , Lindegren ML , Schaffner W , Risk I , Finelli L , Chaves SS . J Infect Dis 2016 214 (4) 507-15 BACKGROUND: We describe the impact of early antiviral treatment among pregnant women hospitalized with laboratory-confirmed influenza (2010-14 influenza seasons). METHODS: Severe influenza was defined as intensive care unit admission, mechanical ventilation, respiratory failure, pulmonary embolism, sepsis, or death. Within severity stratum, we used parametric survival analysis to compare length of stay (LOS) by timing of antiviral treatment, adjusting for underlying conditions, influenza vaccination, and pregnancy trimester. RESULTS: Among 865 pregnant women, median age was 27 years (interquartile range [IQR], 23-31). Most (68%) were healthy, and 85% received antiviral treatment. Sixty-three (7%) women had severe influenza, 4 died. Severity was associated with preterm delivery and fetal loss. Women with severe influenza were less likely to be vaccinated than those without (14% vs. 26%, p=0.03). Comparing women treated with antivirals ≤2 vs. >2 days from illness onset, median LOS (days) was respectively 2.2 (IQR 0.9-5.8; n=8) vs. 7.8 (IQR 3.0-20.6; n=7) for severe (p=0.03), and 2.4 (IQR 2.3-2.5; n=153) vs. 3.1 (IQR 2.8-3.5; n=62) for non-severe influenza (p<0.01). CONCLUSIONS: Early influenza antiviral treatment for pregnant women hospitalized with influenza may reduce LOS, especially if severe influenza. Influenza during pregnancy is associated with maternal and infant morbidity and annual influenza vaccination is warranted. |
Influenza-related hospitalizations and poverty levels - United States, 2010-2012
Hadler JL , Yousey-Hindes K , Perez A , Anderson EJ , Bargsten M , Bohm SR , Hill M , Hogan B , Laidler M , Lindegren ML , Lung KL , Mermel E , Miller L , Morin C , Parker E , Zansky SM , Chaves SS . MMWR Morb Mortal Wkly Rep 2016 65 (5) 101-5 Annual influenza vaccine is recommended for all persons aged ≥6 months in the United States, with recognition that some persons are at risk for more severe disease. However, there might be previously unrecognized demographic groups that also experience higher rates of serious influenza-related disease that could benefit from enhanced vaccination efforts. Socioeconomic status (SES) measures that are area-based can be used to define demographic groups when individual SES data are not available. Previous surveillance data analyses in limited geographic areas indicated that influenza-related hospitalization incidence was higher for persons residing in census tracts that included a higher percentage of persons living below the federal poverty level. To determine whether this association occurs elsewhere, influenza hospitalization data collected in 14 FluSurv-NET sites covering 27 million persons during the 2010-11 and 2011-12 influenza seasons were analyzed. The age-adjusted incidence of influenza-related hospitalizations per 100,000 person-years in high poverty (≥20% of persons living below the federal poverty level) census tracts was 21.5 (95% confidence interval [CI]: 20.7-22.4), nearly twice the incidence in low poverty (<5% of persons living below the federal poverty level) census tracts (10.9, 95% CI: 10.3-11.4). This relationship was observed in each surveillance site, among children and adults, and across racial/ethnic groups. These findings suggest that persons living in poorer census tracts should be targeted for enhanced influenza vaccination outreach and clinicians serving these persons should be made aware of current recommendations for use of antiviral agents to treat influenza. |
Survey of influenza and other respiratory viruses diagnostic testing in US hospitals, 2012-2013.
Su S , Fry AM , Kirley PD , Aragon D , Yousey-Hindes K , Meek J , Openo K , Oni O , Sharangpani R , Morin C , Hollick G , Lung K , Laidler M , Lindegren ML , Schaffner W , Atkinson A , Chaves SS . Influenza Other Respir Viruses 2015 10 (2) 86-90 We sought to assess diagnostic practices for influenza and other respiratory virus in a survey of hospitals and laboratories participating in the US Influenza Hospitalization Surveillance Network in 2012-13. Of the 240 participating laboratories, 67% relied only on commercially-available rapid influenza diagnostic tests to diagnose influenza. Few reported the availability of molecular diagnostic assays for detection of influenza (26%) and other viral pathogens (≤ 20%) in hospitals and commercial laboratories. Reliance on insensitive assays to detect influenza may detract from optimal clinical management of influenza infections in hospitals. |
Active bacterial core surveillance for Legionellosis - United States, 2011-2013
Dooling KL , Toews KA , Hicks LA , Garrison LE , Bachaus B , Zansky S , Carpenter LR , Schaffner B , Parker E , Petit S , Thomas A , Thomas S , Mansmann R , Morin C , White B , Langley GE . MMWR Morb Mortal Wkly Rep 2015 64 (42) 1190-3 During 2000-2011, passive surveillance for legionellosis in the United States demonstrated a 249% increase in crude incidence, although little was known about the clinical course and method of diagnosis. In 2011, a system of active, population-based surveillance for legionellosis was instituted through CDC's Active Bacterial Core surveillance (ABCs) program. Overall disease rates were similar in both the passive and active systems, but more complete demographic information and additional clinical and laboratory data were only available from ABCs. ABCs data during 2011-2013 showed that approximately 44% of patients with legionellosis required intensive care, and 9% died. Disease incidence was higher among blacks than whites and was 10 times higher in New York than California. Laboratory data indicated a reliance on urinary antigen testing, which only detects Legionella pneumophila serogroup 1 (Lp1). ABCs data highlight the severity of the disease, the need to better understand racial and regional differences, and the need for better diagnostic testing to detect infections. |
Impact of prompt influenza antiviral treatment on extended care needs after influenza hospitalization among community-dwelling older adults
Chaves SS , Perez A , Miller L , Bennett NM , Bandyopadhyay A , Farley MM , Fowler B , Hancock EB , Kirley PD , Lynfield R , Ryan P , Morin C , Schaffner W , Sharangpani R , Lindegren ML , Tengelsen L , Thomas A , Hill MB , Bradley KK , Oni O , Meek J , Zansky S , Widdowson MA , Finelli L . Clin Infect Dis 2015 61 (12) 1807-14 BACKGROUND: Patients hospitalized with influenza may require extended care upon discharge. We aimed to explore predictors for extended care needs and the potential mitigating effect of antiviral treatment among community-dwelling adults aged ≥65 years hospitalized with influenza. METHODS: We used laboratory-confirmed influenza hospitalizations from 3 influenza seasons. Extended care was defined as new placement in a skilled nursing home/long-term/rehabilitation facility upon hospital discharge. We focused on those treated with antiviral agents to explore the effect of early treatment on extended care and hospital length of stay (LOS) using logistic regression and competing risk survival analysis, accounting for time from illness onset to hospitalization. Treatment was categorized as early (≤4 days) and late (>4 days) in reference to date of illness onset. RESULTS: Among 6,593 community-dwelling adults aged ≥65 years hospitalized for influenza, 18% required extended care at discharge. Need for care increased with age and neurologic disorders, ICU admission, and pneumonia were predictors of care needs. Early treatment reduced the odds of extended care after hospital discharge for those hospitalized ≤2 or >2 days from illness onset (adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.17, 0.85, and aOR 0.75; 95% CI 0.56, 0.97 respectively). Early treatment was also independently associated with reduction in LOS for those hospitalized ≤2 days from illness onset (adjusted hazard ratio [aHR] 1.81; 95% CI 1.43, 2.30) or >2 days (aHR 1.30; 95% CI 1.20, 1.40). CONCLUSIONS: Prompt antiviral treatment decreases the impact of influenza on older adults through shorten hospitalization and reduced extended care needs. |
Pneumonia among adults hospitalized with laboratory-confirmed seasonal influenza virus infection - United States, 2005-2008
Garg S , Jain S , Dawood FS , Jhung M , Perez A , D'Mello T , Reingold A , Gershman K , Meek J , Arnold KE , Farley MM , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett N , Thomas A , Schaffner W , Finelli L . BMC Infect Dis 2015 15 369 BACKGROUND: Influenza and pneumonia combined are the leading causes of death due to infectious diseases in the United States. We describe factors associated with pneumonia among adults hospitalized with influenza. METHODS: Through the Emerging Infections Program, we identified adults ≥ 18 years, who were hospitalized with laboratory-confirmed influenza during October 2005 through April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of a CXR infiltrate and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. RESULTS: Among 4,765 adults hospitalized with influenza, 1392 (29 %) had pneumonia. In multivariable analysis, factors associated with pneumonia included: age ≥ 75 years, adjusted odds ratio (AOR) 1.27 (95 % confidence interval 1.10-1.46), white race AOR 1.24 (1.03-1.49), nursing home residence AOR 1.37 (1.14-1.66), chronic lung disease AOR 1.37 (1.18-1.59), immunosuppression AOR 1.45 (1.19-1.78), and asthma AOR 0.76 (0.62-0.92). Patients with pneumonia were significantly more likely to require intensive care unit (ICU) admission (27 % vs. 10 %), mechanical ventilation (18 % vs. 5 %), and to die (9 % vs. 2 %). CONCLUSIONS: Pneumonia was present in nearly one-third of adults hospitalized with influenza and was associated with ICU admission and death. Among patients hospitalized with influenza, older patients and those with certain underlying conditions are more likely to have pneumonia. Pneumonia is common among adults hospitalized with influenza and should be evaluated and treated promptly. |
Meteorologically Driven Simulations of Dengue Epidemics in San Juan, PR.
Morin CW , Monaghan AJ , Hayden MH , Barrera R , Ernst K . PLoS Negl Trop Dis 2015 9 (8) e0004002 Meteorological factors influence dengue virus ecology by modulating vector mosquito population dynamics, viral replication, and transmission. Dynamic modeling techniques can be used to examine how interactions among meteorological variables, vectors and the dengue virus influence transmission. We developed a dengue fever simulation model by coupling a dynamic simulation model for Aedes aegypti, the primary mosquito vector for dengue, with a basic epidemiological Susceptible-Exposed-Infectious-Recovered (SEIR) model. Employing a Monte Carlo approach, we simulated dengue transmission during the period of 2010-2013 in San Juan, PR, where dengue fever is endemic. The results of 9600 simulations using varied model parameters were evaluated by statistical comparison (r2) with surveillance data of dengue cases reported to the Centers for Disease Control and Prevention. To identify the most influential parameters associated with dengue virus transmission for each period the top 1% of best-fit model simulations were retained and compared. Using the top simulations, dengue cases were simulated well for 2010 (r2 = 0.90, p = 0.03), 2011 (r2 = 0.83, p = 0.05), and 2012 (r2 = 0.94, p = 0.01); however, simulations were weaker for 2013 (r2 = 0.25, p = 0.25) and the entire four-year period (r2 = 0.44, p = 0.002). Analysis of parameter values from retained simulations revealed that rain dependent container habitats were more prevalent in best-fitting simulations during the wetter 2010 and 2011 years, while human managed (i.e. manually filled) container habitats were more prevalent in best-fitting simulations during the drier 2012 and 2013 years. The simulations further indicate that rainfall strongly modulates the timing of dengue (e.g., epidemics occurred earlier during rainy years) while temperature modulates the annual number of dengue fever cases. Our results suggest that meteorological factors have a time-variable influence on dengue transmission relative to other important environmental and human factors. |
Statin treatment and mortality: propensity score-matched analyses of 2007-2008 and 2009-2010 laboratory-confirmed influenza hospitalizations
Laidler MR , Thomas A , Baumbach J , Kirley PD , Meek J , Aragon D , Morin C , Ryan PA , Schaffner W , Zansky SM , Chaves SS . Open Forum Infect Dis 2015 2 (1) ofv028 BACKGROUND: Annual influenza epidemics are responsible for substantial morbidity and mortality. The use of immunomodulatory agents such as statins to target host inflammatory responses in influenza virus infection has been suggested as an adjunct treatment, especially during pandemics, when antiviral quantities are limited or vaccine production can be delayed. METHODS: We used population-based, influenza hospitalization surveillance data, propensity score-matched analysis, and Cox regression to determine whether there was an association between mortality (within 30 days of a positive influenza test) and statin treatment among hospitalized cohorts from 2 influenza seasons (October 1, 2007 to April 30, 2008 and September 1, 2009 to April 31, 2010). RESULTS: Hazard ratios for death within the 30-day follow-up period were 0.41 (95% confidence interval [CI], .25-.68) for a matched sample from the 2007-2008 season and 0.77 (95% CI, .43-1.36) for a matched sample from the 2009 pandemic. CONCLUSIONS: The analysis suggests a protective effect against death from influenza among patients hospitalized in 2007-2008 but not during the pandemic. Sensitivity analysis indicates the findings for 2007-2008 may be influenced by unmeasured confounders. This analysis does not support using statins as an adjunct treatment for preventing death among persons hospitalized for influenza. |
Does influenza vaccination modify influenza disease severity? Data on older adults hospitalized with influenza during the 2012-13 season in the United States
Arriola CS , Anderson EJ , Baumbach J , Bennett N , Bohm S , Hill M , Lindegren ML , Lung K , Meek J , Mermel E , Miller L , Monroe ML , Morin C , Oni O , Reingold A , Schaffner W , Thomas A , Zansky SM , Finelli L , Chaves SS . J Infect Dis 2015 212 (8) 1200-8 BACKGROUND: Some studies suggest that influenza vaccination might be protective against severe influenza outcomes in vaccinated persons who become infected. We used data from a large surveillance network to further investigate the effect of influenza vaccination on influenza disease severity in adults aged ≥50 years hospitalized with laboratory-confirmed influenza. METHODS: We analyzed influenza vaccination and influenza severity using Influenza Hospitalization Surveillance Network (FluSurv-NET) data for the 2012-13 influenza season. Intensive care unit (ICU) admission, death, diagnosis of pneumonia, and hospital and ICU lengths of stay served as measures of disease severity. Data were analyzed by multivariable logistic regression, parametric survival models and propensity score matching (PSM). RESULTS: Overall, no differences in severity were observed in the multivariable logistic regression model. Using PSM, adults aged 50-64 years (but not other age groups) who were vaccinated against influenza had a shorter ICU length of stay compared to those unvaccinated (HR for discharge=1.84, 95% CI: 1.12-3.01). CONCLUSION: Our findings show a modest effect of influenza vaccination on disease severity. Analysis of data from seasons with different predominant strains and higher estimates of vaccine effectiveness are needed. |
A virus-like particle system identifies the endonuclease domain of Crimean-Congo hemorrhagic fever virus.
Devignot S , Bergeron E , Nichol S , Mirazimi A , Weber F . J Virol 2015 89 (11) 5957-67 Crimean-Congo Hemorrhagic Fever virus (CCHFV; genus Nairovirus) is an extremely pathogenic member of the Bunyaviridae family. Since handling of the virus requires a BSL-4 facility, little is known about pathomechanisms and host interactions. Here, we describe the establishment of a transcriptionally competent (tc)-VLP system for CCHFV. Recombinant polymerase (L), nucleocapsid protein (N) and a reporter minigenome expressed in human HuH-7 cells resulted in formation of transcriptionally active nucleocapsids that could be packaged by co-expressed CCHFV glycoproteins into tc-VLPs. The tc-VLPs resembled authentic virus particles in their protein composition and neutralization sensitivity to anti-CCHFV antibodies, and could recapitulate all steps of the viral replication cycle. Particle attachment, entry and primary transcription were modelled by infection of naive cells. The subsequent steps of genome replication, secondary transcription, and particle assembly and release can be obtained upon passaging the tc-VLPs on cells expressing CCHFV structural proteins. The utility of the VLP system was demonstrated by showing that the endonuclease domain of L is located around amino acid D693, as it was predicted in silico by Morin et al. (PLoS Pathogens 6: e1001038). The tc-VLP system will greatly facilitate studies and diagnostics of CCHFV under non-BSL-4 conditions. IMPORTANCE: Crimean-Congo Hemorrhagic Fever virus (CCHFV) is an extremely virulent pathogen of humans. Since the virus can only be handled at the highest biosafety level, research is restricted to a few specialized laboratories. We developed a plasmid-based system to produce virus-like particles with the ability to infect cells and transcribe a reporter genome. Due to the absence of viral genes, the virus-like particles are unable to spread or cause disease, thus allowing to study aspects of CCHFV biology under relaxed biosafety conditions. |
Variant influenza associated with live animal markets, Minnesota
Choi MJ , Morin CA , Scheftel J , Vetter SM , Smith K , Lynfield R . Zoonoses Public Health 2014 62 (5) 326-30 Variant influenza viruses are swine-origin influenza A viruses that cause illness in humans. Surveillance for variant influenza A viruses, including characterization of exposure settings, is important because of the potential emergence of novel influenza viruses with pandemic potential. In Minnesota, we have documented variant influenza A virus infections associated with swine exposure at live animal markets. |
Complications among adults hospitalized with influenza: a comparison of seasonal influenza and the 2009 H1N1 pandemic
Reed C , Chaves SS , Perez A , D'Mello T , Kirley PD , Aragon D , Meek JI , Farley MM , Ryan P , Lynfield R , Morin CA , Hancock EB , Bennett NM , Zansky SM , Thomas A , Lindegren ML , Schaffner W , Finelli L . Clin Infect Dis 2014 59 (2) 166-74 BACKGROUND: Persons with influenza can develop complications that result in hospitalization and death. These are most commonly respiratory-related, but cardiovascular or neurologic complications or exacerbations of underlying chronic medical conditions may also occur. Patterns of complications observed during pandemics may differ from typical influenza seasons, and characterizing variations in influenza-related complications can provide a better understanding of the impact of pandemics and guide appropriate clinical management and planning for the future. METHODS: Using a population-based surveillance system, we compared clinical complications using ICD-9 discharge diagnosis codes in adults hospitalized with seasonal influenza (n=5,270) or 2009 pandemic influenza A(H1N1) (H1N1pdm09) (n=4,962). RESULTS: Adults hospitalized with H1N1pdm09 were younger (median age 47 years) than those with seasonal influenza (median: 68 years, p<0.01), and differed in the frequency of certain underlying medical conditions. While there was similar risk for many influenza-associated complications, after controlling for age and type of underlying medical condition adults hospitalized with H1N1pdm09 were more likely to have lower respiratory tract complications, shock/sepsis, and organ failure than those with seasonal influenza. They were also more likely to be admitted to the ICU, require mechanical ventilation, or die. Young adults, in particular, had 2-4 times the risk of severe outcomes from H1N1pdm09 than persons of the same ages with seasonal influenza. CONCLUSIONS: While thought of as a relatively mild pandemic, these data highlight the impact of the 2009 pandemic on the risk of severe influenza, especially among younger adults, and the impact this virus may continue to have. |
Comparing clinical characteristics between hospitalized adults with laboratory-confirmed influenza A and B virus infection
Su S , Chaves SS , Perez A , D'Mello T , Kirley PD , Yousey-Hindes K , Farley MM , Harris M , Sharangpani R , Lynfield R , Morin C , Hancock EB , Zansky S , Hollick GE , Fowler B , McDonald-Hamm C , Thomas A , Horan V , Lindegren ML , Schaffner W , Price A , Bandyopadhyay A , Fry AM . Clin Infect Dis 2014 59 (2) 252-5 We challenge the notion that influenza B virus infection is milder than influenza A virus infection by finding similar clinical characteristics and outcomes between adults hospitalized with these two types of influenza. Among patients treated with oseltamivir, length of stay and mortality did not differ by type of virus infection. |
Child, household, and caregiver characteristics associated with hospitalization for influenza among children 6-59 months of age: an Emerging Infections Program study
Dharan NJ , Sokolow LZ , Cheng PY , Gargiullo P , Gershman K , Lynfield R , Morin C , Thomas A , Meek J , Farley MM , Arnold KE , Reingold A , Craig AS , Schaffner W , Bennett NM , Zansky S , Baumbach J , Lathrop S , Kamimoto L , Shay DK . Pediatr Infect Dis J 2014 33 (6) e141-50 BACKGROUND: Young children are at increased risk of severe outcomes from influenza illness, including hospitalization. We conducted a case-control study to identify risk factors for influenza-associated hospitalizations among children in U.S. Emerging Infections Program sites. METHODS: Cases were children 6-59 months of age hospitalized for laboratory-confirmed influenza infections during 2005-08. Age- and zip-code-matched controls were enrolled. Data on child, caregiver, and household characteristics were collected from parents and medical records. Conditional logistic regression was used to identify independent risk factors for hospitalization. RESULTS: We enrolled 290 (64%) of 454 eligible cases and 1,089 (49%) of 2,204 eligible controls. Risk for influenza hospitalization increased with maternal age <26 years (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.9); household income below the poverty threshold (OR 2.2, CI 1.4-3.6); smoking by >50% of household members (OR 2.9, CI 1.4-6.6); lack of household influenza vaccination (OR 1.8, CI 1.2-2.5); and presence of chronic illnesses, including hematologic/oncologic (OR 11.8, CI 4.5-31.0), pulmonary (OR 2.9, CI 1.9-4.4), and neurologic (OR 3.8, CI 1.6-9.2) conditions. Full influenza immunization decreased the risk among children aged 6-23 months (OR 0.5, CI 0.3-0.9) but not among those 24-59 months of age (OR 1.5, CI 0.8-3.0; p-value for difference = 0.01). CONCLUSIONS: Chronic illnesses, young maternal age, poverty, household smoking, and lack of household influenza vaccination increased the risk of influenza hospitalization. These characteristics may help providers to identify young children who are at greatest risk for severe outcomes from influenza illness. |
Hospital-onset influenza hospitalizations - United States, 2010-2011
Jhung MA , D'Mello T , Perez A , Aragon D , Bennett NM , Cooper T , Farley MM , Fowler B , Grube SM , Hancock EB , Lynfield R , Morin C , Reingold A , Ryan P , Schaffner W , Sharangpani R , Tengelsen L , Thomas A , Thurston D , Yousey-Hindes K , Zansky S , Finelli L , Chaves SS . Am J Infect Control 2014 42 (1) 7-11 BACKGROUND: Seasonal influenza is responsible for more than 200,000 hospitalizations each year in the United States. Although hospital-onset (HO) influenza contributes to morbidity and mortality among these patients, little is known about its overall epidemiology. OBJECTIVE: We describe patients with HO influenza in the United States during the 2010-2011 influenza season and compare them with community-onset (CO) cases to better understand factors associated with illness. METHODS: We identified laboratory-confirmed, influenza-related hospitalizations using the Influenza Hospitalization Surveillance Network (FluSurv-NET), a network that conducts population-based surveillance in 16 states. CO cases had laboratory confirmation ≤ 3 days after hospital admission; HO cases had laboratory confirmation > 3 days after admission. RESULTS: We identified 172 (2.8%) HO cases among a total of 6,171 influenza-positive hospitalizations. HO and CO cases did not differ by age (P = .22), sex (P = .29), or race (P = .25). Chronic medical conditions were more common in HO cases (89%) compared with CO cases (78%) (P < .01), and a greater proportion of HO cases (42%) than CO cases (17%) were admitted to the intensive care unit (P < .01). The median length of stay after influenza diagnosis of HO cases (7.5 days) was greater than that of CO cases (3 days) (P < .01). CONCLUSION: HO cases had greater length of stay and were more likely to be admitted to the intensive care unit or die compared with CO cases. HO influenza may play a role in the clinical outcome of hospitalized patients, particularly among those with chronic medical conditions. |
Outbreak of variant influenza A(H3N2) virus in the United States
Jhung MA , Epperson S , Biggerstaff M , Allen D , Balish A , Barnes N , Beaudoin A , Berman L , Bidol S , Blanton L , Blythe D , Brammer L , D'Mello T , Danila R , Davis W , de Fijter S , Diorio M , Durand LO , Emery S , Fowler B , Garten R , Grant Y , Greenbaum A , Gubareva L , Havers F , Haupt T , House J , Ibrahim S , Jiang V , Jain S , Jernigan D , Kazmierczak J , Klimov A , Lindstrom S , Longenberger A , Lucas P , Lynfield R , McMorrow M , Moll M , Morin C , Ostroff S , Page SL , Park SY , Peters S , Quinn C , Reed C , Richards S , Scheftel J , Simwale O , Shu B , Soyemi K , Stauffer J , Steffens C , Su S , Torso L , Uyeki TM , Vetter S , Villanueva J , Wong KK , Shaw M , Bresee JS , Cox N , Finelli L . Clin Infect Dis 2013 57 (12) 1703-12 BACKGROUND: Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) first identified in 2011. METHODS: We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v transmission if swine contact was not identified within 4 days prior to illness onset. RESULTS: From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v. Viruses recovered from patients were 93%-100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications. CONCLUSIONS: In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings. |
Safe, stable, nurturing relationships break the intergenerational cycle of abuse: a prospective nationally representative cohort of children in the United kingdom
Jaffee SR , Bowes L , Ouellet-Morin I , Fisher HL , Moffitt TE , Merrick MT , Arseneault L . J Adolesc Health 2013 53 S4-S10 PURPOSE: To identify contextual and interpersonal factors that distinguish families in which the intergenerational transmission of maltreatment is maintained from families in which the cycle is broken. METHODS: The sample was composed of 1,116 families in the United Kingdom who participated in the Environmental Risk (E-Risk) Longitudinal Twin Study. We assessed mother's childhood history of maltreatment retrospectively with a validated and reliable interview. Prospective reports of children's physical maltreatment were collected repeatedly up to 12 years. We compared families in which mothers but not children had experienced maltreatment with families in which both mothers and children had experienced maltreatment, and with families without maltreatment, on a range of contextual and interpersonal factors known to affect child development. RESULTS: In multivariate analyses, supportive and trusting relationships with intimate partners, high levels of maternal warmth toward children, and low levels of partner violence between adults distinguished families in which mothers but not children experienced maltreatment from families in which mothers and children experienced maltreatment. Families in which only mothers experienced maltreatment were largely similar to families in which neither generation experienced maltreatment, except that mothers belonging to the former group were more likely to have a lifetime history of depression and low levels of social support. CONCLUSIONS: Safe, stable, nurturing relationships between intimate partners and between mothers and children are associated with breaking the cycle of abuse in families. Additional research is needed to determine whether these factors have a causal role in preventing the transmission of maltreatment from one generation to the next. |
Increase in rates of hospitalization due to laboratory-confirmed influenza among children and adults during the 2009-10 influenza pandemic
Cox CM , D'Mello T , Perez A , Reingold A , Gershman K , Yousey-Hindes K , Arnold KE , Farley MM , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett NM , Thomas A , Schaffner W , Finelli L . J Infect Dis 2012 206 (9) 1350-8 BACKGROUND: The Emerging Infections Programs (EIP) network has conducted population-based surveillance for hospitalizations due to laboratory-confirmed influenza among children since 2003, with the network expanding in 2005 to include adults. METHODS: From 15 April 2009 through 30 April 2010, the EIP conducted surveillance among 22.1 million people residing in 10 states. Incidence rates per 100,000 population were calculated using US Census Bureau data. Mean historic rates were calculated on the basis of previously published and unpublished EIP data. RESULTS: During the 2009 pandemic of influenza A virus subtype H1N1 infection, rates of hospitalizations due to laboratory-confirmed influenza were 202, 88, 49, 31, 27, 36, 28, and 27 episodes per 100,000 among persons aged <6 months, 6-23 months, 2-4 years, 5-17 years, 18-49 years, 50-64 years, 65-74 years, and ≥75 years, respectively. Comparative mean rates from previous influenza seasons during which EIP conducted surveillance were 153, 53, 20, 6, 4, 8, 20, and 56 episodes per 100,000 among persons aged <6 months, 6-23 months, 2-4 years, 5-17 years, 18-49 years, 50-64 years, 65-74 years, and ≥75 years, respectively. CONCLUSIONS: During the pandemic, rates of hospitalization due to laboratory-confirmed influenza among individuals aged 5-17 years and 18-49 years increased 5-fold and 6-fold, respectively, compared with mean rates from previous influenza seasons. Hospitalization rates for other pediatric and adult age groups increased, compared with mean rates from previous influenza seasons, whereas the rate among individuals aged ≥75 years decreased. |
Reduced influenza antiviral treatment among children and adults hospitalized with laboratory-confirmed influenza infection in the year following the 2009 pandemic
Garg S , Chaves SS , Perez A , D'Mello T , Gershman K , Meek J , Yousey-Hindes K , Arnold KE , Farley MM , Tengelsen L , Ryan P , Sharangpani R , Lynfield R , Morin C , Baumbach J , Hancock EB , Zansky S , Bennett NM , Fowler B , Bradley K , Thomas A , Cooper T , Schaffner W , Boulton R , Finelli L , Fry A . Clin Infect Dis 2012 55 (3) e18-21 Influenza antiviral treatment is recommended for all persons hospitalized with influenza virus infection. During the 2010-2011 influenza season, antiviral treatment of children and adults hospitalized with laboratory-confirmed influenza declined significantly compared to treatment during the 2009 pandemic (children: 56% versus 77%, p <0.01; adults 77% versus 82%, p<0.01). |
Influenza-associated hospitalizations by industry, 2009-10 influenza season, United States
Luckhaupt SE , Sweeney MH , Funk R , Calvert GM , Nowell M , D'Mello T , Reingold A , Meek J , Yousey-Hindes K , Arnold KE , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Jones T . Emerg Infect Dis 2012 18 (4) 556-562 In response to pandemic (H1N1) 2009, data were collected on work status and industry of employment of 3,365 adults hospitalized with laboratory-confirmed influenza during the 2009-10 influenza season in the United States. The proportion of workers hospitalized for influenza was lower than their proportion in the general population, reflecting underlying protective characteristics of workers compared with nonworkers. The most commonly represented sectors were transportation and warehousing; administrative and support and waste management and remediation services; health care; and accommodation and food service. |
The burden of invasive early-onset neonatal sepsis in the United States, 2005-2008
Weston EJ , Pondo T , Lewis MM , Martell-Cleary P , Morin C , Jewell B , Daily P , Apostol M , Petit S , Farley M , Lynfield R , Reingold A , Hansen NI , Stoll BJ , Shane AJ , Zell E , Schrag SJ . Pediatr Infect Dis J 2011 30 (11) 937-941 BACKGROUND: Sepsis in the first 3 days of life is a leading cause of morbidity and mortality among infants. Group B Streptococcus (GBS), historically the primary cause of early-onset sepsis (EOS), has declined through widespread use of intrapartum chemoprophylaxis. We estimated the national burden of invasive EOS cases and deaths in the era of GBS prevention. METHODS: Population-based surveillance for invasive EOS was conducted in 4 of the Centers for Disease Control and Prevention's Active Bacterial Core surveillance sites from 2005 to 2008. We calculated incidence using state and national live birth files. Estimates of the national number of cases and deaths were calculated, standardizing by race and gestational age. RESULTS: Active Bacterial Core surveillance identified 658 cases of EOS; 72 (10.9%) were fatal. Overall incidence remained stable during the 3 years (2005: 0.77 cases/1000 live births; 2008: 0.76 cases/1000 live births). GBS ( approximately 38%) was the most commonly reported pathogen followed by Escherichia coli ( approximately 24%). Black preterm infants had the highest incidence (5.14 cases/1000 live births) and case fatality (24.4%). Nonblack term infants had the lowest incidence (0.40 cases/1000 live births) and case fatality (1.6%). The estimated national annual burden of EOS was approximately 3320 cases (95% confidence interval [CI]: 3060-3580), including 390 deaths (95% CI: 300-490). Among preterm infants, 1570 cases (95% CI: 1400-1770; 47.3% of the overall) and 360 deaths (95% CI: 280-460; 92.3% of the overall) occurred annually. CONCLUSIONS: The burden of invasive EOS remains substantial in the era of GBS prevention and disproportionately affects preterm and black infants. Identification of strategies to prevent preterm births is needed to reduce the neonatal sepsis burden. |
Description of antiviral treatment among adults hospitalized with influenza before and during the 2009 pandemic: United States, 2005-2009
Doshi S , Kamimoto L , Finelli L , Perez A , Reingold A , Gershman K , Yousey-Hindes K , Arnold K , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock EB , Bennett NM , Zansky S , Thomas A , Schaffner W , Fry AM . J Infect Dis 2011 204 (12) 1848-56 BACKGROUND: The 2009 influenza pandemic led to guidelines emphasizing antiviral treatment for all persons hospitalized with influenza, including pregnant women. We compared antiviral use among adults hospitalized with influenza before and during the pandemic. METHODS: The Emerging Infections Program conducts active population-based surveillance for persons hospitalized with community-acquired, laboratory-confirmed influenza in 10 states. We analyzed data collected via medical record review of patients aged ≥18 years admitted during prepandemic (1 October 2005 through 14 April 2009) and pandemic (15 April 2009 through 31 December 2009) time frames. RESULTS: Of 5943 adults hospitalized with influenza in prepandemic seasons, 3235 (54%) received antiviral treatment, compared with 4055 (82%) of 4966 during the pandemic. Forty-one (22%) of 187 pregnant women received antiviral treatment in prepandemic seasons, compared with 369 (86%) of 430 during the pandemic. Pregnancy was a negative predictor of antiviral treatment before the pandemic (adjusted odds ratio [aOR], 0.24; 95% confidence interval [CI], .16-.35) but was independently associated with treatment during the pandemic (aOR, 1.97; 95% CI, 1.32-2.96). Antiviral treatment among adults hospitalized >2 days after illness onset increased from 43% before the pandemic to 79% during the pandemic (P < .001). CONCLUSIONS: Antiviral treatment of hospitalized adults increased during the pandemic, especially among pregnant women. This suggests that many clinicians followed published guidance to treat hospitalized adults with antiviral agents. However, compliance with antiviral recommendations could be improved. |
Children with asthma hospitalized with seasonal or pandemic influenza, 2003-2009
Dawood FS , Kamimoto L , D'Mello TA , Reingold A , Gershman K , Meek J , Arnold KE , Farley M , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett N , Thomas A , Schaffner W , Kirschke D , Finelli L . Pediatrics 2011 128 (1) e27-32 OBJECTIVE: To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type. METHODS: During the 2003-2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2-17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus). We collected data from medical records on medical history and clinical course; data on asthma severity and control were not routinely collected. RESULTS: During the 2003-2009 influenza seasons, 701 (32%) of 2165 children hospitalized with influenza had asthma; during the 2009 pandemic, 733 (44%) of 1660 children had asthma. The median age of the asthmatic children was 7 years, and 73% had no additional medical conditions. Compared with asthmatic children with seasonal influenza, a higher proportion with 2009 pandemic H1N1 influenza required intensive care (16% vs 22%; P = .01) and were diagnosed with pneumonia (40% vs 46%; P = .04), whereas equal proportions had respiratory failure (5% vs 5%; P = .8) and died (1% vs 1%; P = .4). More asthmatic children with influenza A (seasonal or pandemic) had diagnoses of asthma exacerbations compared with those with influenza B (51% vs 29%; P < .01). CONCLUSIONS: The majority of asthmatic children hospitalized with influenza have no additional medical conditions. Complications such as pneumonia and need for intensive care occur in a substantial proportion, highlighting the importance of influenza prevention through vaccination among asthmatic children. |
Seasonal and 2009 pandemic influenza A (H1N1) virus infection during pregnancy: a population-based study of hospitalized cases
Creanga AA , Kamimoto L , Newsome K , D'Mello T , Jamieson DJ , Zotti ME , Arnold KE , Baumbach J , Bennett NM , Farley MM , Gershman K , Kirschke D , Lynfield R , Meek J , Morin C , Reingold A , Ryan P , Schaffner W , Thomas A , Zansky S , Finelli L , Honein MA . Am J Obstet Gynecol 2011 204 S38-45 We sought to describe characteristics of hospitalized reproductive-aged (15-44 years) women with seasonal (2005/2006 through 2008/2009) and 2009 pandemic influenza A (H1N1) virus infection. We used population-based data from the Emerging Infections Program in 10 US states, and compared characteristics of pregnant (n = 150) and nonpregnant (n = 489) seasonal, and pregnant (n = 489) and nonpregnant (n = 1088) pandemic influenza cases using chi(2) and Fisher's exact tests. Pregnant women represented 23.5% and 31.0% of all reproductive-aged women hospitalized for seasonal and pandemic influenza, respectively. Significantly more nonpregnant than pregnant women with seasonal (71.2% vs 36.0%) and pandemic (69.7% vs 31.9%) influenza had an underlying medical condition other than pregnancy. Antiviral treatment was significantly more common with pandemic than seasonal influenza for both pregnant (86.5% vs 24.0%) and nonpregnant (82.0% vs 55.2%) women. Pregnant women comprised a significant proportion of influenza-hospitalized reproductive-aged women, underscoring the importance of influenza vaccination during pregnancy. |
Adult hospitalizations for laboratory-positive influenza during the 2005-2006 through 2007-2008 seasons in the United States
Dao CN , Kamimoto L , Nowell M , Reingold A , Gershman K , Meek J , Arnold KE , Farley M , Ryan P , Lynfield R , Morin C , Baumbach J , Hancock E , Zansky S , Bennett NM , Thomas A , Vandermeer M , Kirschke DL , Schaffner W , Finelli L . J Infect Dis 2010 202 (6) 881-8 BACKGROUND: Rates of influenza-associated hospitalizations in the United States have been estimated using modeling techniques with data from pneumonia and influenza hospitalization discharge diagnoses, but they have not been directly estimated from laboratory-positive cases. METHODS: We calculated overall, age-specific, and site-specific rates of laboratory-positive, influenza-associated hospitalization among adults and compared demographic and clinical characteristics and outcomes of hospitalized cases by season with use of data collected by the Emerging Infections Program Network during the 2005-2006 through 2007-2008 influenza seasons. RESULTS: Overall rates of adult influenza-associated hospitalization per 100,000 persons were 9.9 during the 2005-2006 season, 4.8 during the 2006-2007 season, and 18.7 during the 2007-2008 season. Rates of hospitalization varied by Emerging Infections Program site and increased with increasing age. Higher overall and age-specific rates of hospitalization were observed during influenza A (H3) predominant seasons and during periods of increased circulation of influenza B. More than 80% of hospitalized persons each season had 1 underlying medical condition, including chronic cardiovascular and metabolic diseases. CONCLUSIONS: Rates varied by season, age, geographic location, and type/subtype of circulating influenza viruses. Influenza-associated hospitalization surveillance is essential for assessing the relative severity of influenza seasons over time and the burden of influenza-associated complications. |
Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008
Dawood FS , Fiore A , Kamimoto L , Bramley A , Reingold A , Gershman K , Meek J , Hadler J , Arnold KE , Ryan P , Lynfield R , Morin C , Mueller M , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Kirschke D , Finelli L . J Pediatr 2010 157 (5) 808-14 OBJECTIVES: To estimate the rates of hospitalization with seasonal influenza in children aged <18 years from a large, diverse surveillance area during 2003 to 2008. STUDY DESIGN: Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children. Hospitalized children were identified retrospectively; clinicians made influenza testing decisions. Data collected from the hospital record included demographics, medical history, and clinical course. Incidence rates were calculated with census data. RESULTS: The highest hospitalization rates occurred in children aged <6 months (seasonal range, 9-30/10 000 children), and the lowest rates occurred in children aged 5 to 17 years (0.3-0.8/10 000). Overall, 4015 children were hospitalized, 58% of whom were identified with rapid diagnostic tests alone. Forty percent of the children who were hospitalized had underlying medical conditions; asthma (18%), prematurity (15% of children aged <2 years), and developmental delay (7%) were the most common. Severe outcomes included intensive care unit admission (12%), respiratory failure (5%), bacterial coinfection (2%), and death (0.5%). CONCLUSIONS: Influenza-associated hospitalization rates varied by season and age and likely underestimate true rates because many hospitalized children are not tested for influenza. The proportion of children with severe outcomes was substantial across seasons. Quantifying incidence of influenza hospitalization and severe outcomes is critical to defining disease burden. |
Influenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003-2008
Dawood FS , Fiore A , Kamimoto L , Nowell M , Reingold A , Gershman K , Meek J , Hadler J , Arnold KE , Ryan P , Lynfield R , Morin C , Baumbach J , Zansky S , Bennett NM , Thomas A , Schaffner W , Kirschke D , Finelli L . Pediatr Infect Dis J 2010 29 (7) 585-90 BACKGROUND: Pneumonia is one of the most common complications in children hospitalized with influenza. We describe hospitalized children with influenza-associated pneumonia and associated risk indicators. METHODS: Through Emerging Infections Program Network population based surveillance, children aged <18 years hospitalized with laboratory confirmed influenza with a chest radiograph during hospitalization were identified during the 2003-2008 influenza seasons. A case with radiologically confirmed influenza-associated pneumonia was defined as a child from the surveillance area hospitalized with: (1) laboratory-confirmed influenza and (2) evidence of new pneumonia on chest radiograph during hospitalization. Hospitalized children with pneumonia were compared with those without pneumonia by univariate and multivariate analysis. RESULTS: Overall, 2992 hospitalized children with influenza with a chest radiograph were identified; 1072 (36%) had influenza-associated pneumonia.When compared with children hospitalized with influenza without pneumonia, hospitalized children with influenza-associated pneumonia were more likely to require intensive care unit admission (21% vs. 11%, P < 0.01), develop respiratory failure (11% versus 3%, P < 0.01), and die(0.9% vs. 0.3% P 0.01). In multivariate analysis, age 6 to 23 months(adjusted OR: 2.1, CI: 1.6 -2.8), age 2 to 4 years (adjusted OR: 1.7, CI:1.3-2.2), and asthma (adjusted OR: 1.4, CI: 1.1-1.8) were significantly associated with influenza-associated pneumonia. CONCLUSIONS: Hospitalized children with influenza-associated pneumonia were more likely to have a severe clinical course than other hospitalized children with influenza, and children aged 6 months to 4 years and those with asthma were more likely to have influenza-associated pneumonia. Identifying children at greater risk for influenza-associated pneumonia will inform prevention and treatment strategies targeting children at risk for influenza complications. |
Invasive group B streptococcal disease in the elderly, Minnesota, USA, 2003-2007
Kothari NJ , Morin CA , Glennen A , Jackson D , Harper J , Schrag SJ , Lynfield R . Emerg Infect Dis 2009 15 (8) 1279-81 In Minnesota, incidence of invasive group B streptococcal disease was 3 times greater in older adults in long-term care facilities than in older adults in community settings (67.7/100,000 vs. 21.4/100,000) during 2003-2007. The overall case-fatality rate was 6.8%, and concurrent conditions were common among both groups. |
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